Finished the USMLE today - and thought it was comparable to COMLEX in difficulty. I had a lot of genetics, embryo, and biochem on my exam. I actually went and spoke with the proctor during the break to see if the test was "adaptive" - I was beginning to think they were going to keep asking the same topics until I got some correct :wink: . I marked roughly 10 questions in each 50 question block to return to in more depth, but there were also questions that I just guessed at and didn't mark since no length of staring at the questions was going to give me the correct answer.
Phsyiology ,pathology, and microbiology were of moderate difficulty - I would know the disease and processes involved, but the question would deal with an obscure biochemical or genetic pathway involved in the disease. I didn't have a single question regarding renal, but they hammered the clotting cascade over and over. Only three Neuroanatomy questions, and all three had pictures for me to identify the structures associated with the pathological processes described.
The pictures were of good to excellent quality, and there was only 1 question I could have disputed for having no correct answer (I verified this when I got home). I sure liked getting the testing completed in one day vs. two on COMLEX.